Brucellosis in children in Bosnia and Herzegovina in the period 2000 - 2013.

AIM: To analyse clinical, laboratory and epidemiological characteristics of brucellosis in children in Bosnia and Herzegovina. METHODS: The study included 246 children aged 0-18 years, who were hospitalized in Clinics and Departments for Infectious Diseases in Tuzla, Sarajevo, Banja Luka, Zenica and Bihac in the period 2000-2013, in whom the diagnosis of brucellosis was established based on anamnestic data, clinical features and positive results from blood culture and/or positive results from one of the serological tests. RESULTS: In this period, a total of 2630 patients, 246 (9.35%) of whom were children, were treated from brucellosis at the Clinics and Departments in Bosnia and Herzegovina. In the majority of cases, the children were from rural parts of the country, 226 (91.87%);214 (87.04%) cases had direct contact with sick animals, sick family member or consumption of unpasteurized dairy products from farms where brucellosis had been already established. Male children predominated, 157 (63.82%). The most frequent clinical features in affected children were fever, 194 (78.86%) and joint pain, 158 (64.22%). The average duration of antimicrobial treatment was 42.85 ± 10.67 days. A total of 228 (92.68%) children were completely cured, while relapses occurred in 18 (7.32%) children. CONCLUSION: Since brucellosis is an endemic disease in Bosnia and Herzegovina, it is important that physicians in their daily practice consider brucellosis and establish proper diagnosis and therapy in children with prolonged fever, arthralgia, leukopenia and positive epidemiological data, especially in rural parts of the country.

Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran--a prospective multicenter point prevalence study.

OBJECTIVE: We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia. METHODS: A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists. RESULTS: Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%). CONCLUSION: ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area.

Staphylococcal bacteraemia/sepsis-characteristics of laboratory parameters.

INTRODUCTION: While determining a diagnosis and during a disease follow-up, laboratory, or non-specific inflammatory parameters in particular, platelets reference values, nitrogen matters, and liver enzymes play a significant role because their values may indicate multiple organ failures. GOALS: To analyse laboratory parameters in patients diagnosed with the staphylococcal bacteraemia/sepsis. PATIENTS AND METHODS: Analysed patients have been treated at the Clinic for Infectious Diseases through the period often years. RESULTS: Differences in average CRP values, leucocytes, neutrophils and platelets among the patients diagnosed with the sepsis and bacteraemia are not statistically relevant p > 0,05. Difference in the average sedimentation values of the erythrocytes between the patients diagnosed with the sepsis and the patients diagnosed with the bacteraemia are statistically relevant p = 0,035. Differences between the average INR values between the patients diagnosed with sepsis and the patients with bacteraemia are not statistically significant, but indicative p = 0,051. Differences in the average blood sugar values, urea, creatinine, bilirubin and ALT between the patients diagnosed with bacteraemia and sepsis are not statistically significant p > 0.05. CONCLUSION: The results have showed that even in the course ofa bacteraemia, there is a significant increase in the non-specific inflammatory parameters indicating the gravity ofbacteraemia as well, with a constant risk of developing sepsis and septic shock. The importance of running and following-up the laboratory parameters herewith is emphasised for the purpose of detecting sepsis in a timely manner and administering an adequate therapy.

Frequency of in-hospital acquired staphylococcus bacteremia/sepsis within ten-year period.

UNLABELLED: Analyzing data in the literature, it is noted that in-hospital acquired infections are an increasing problem even in more developed countries. This increasing trend is related to the progress of medical science and introduction of new invasive diagnostic-therapeutic methods, as well as increase of multiresistant types of bacteria, including staphylococci in big percentages. GOALS: To analyze frequency of in-hospital acquired staphylococcus bacteremia/sepsis. PATIENTS AND METHODS: Anamneses of patients who were diagnosed with staphylococcus bacteremia/sepsis were analyzed within a ten-year period. RESULTS: Within the analyzed period from 2001 to 2011, there were 87 patients with diagnosis of staphylococcus bacteremia/sepsis, out of which (20) 77% were diagnosed with sepsis, and (67) 23% with bacteremia. In-hospital outcome was present with 32 (36.8%) patients, while 55 (63.2%) were out of hospital. The chi-square test for independence showed that the diagnosis of bacteremia/sepsis and the place of the infection origin (in hospital/ out of hospital) were independent chi2 = 1.951 df= 1 p=0.162. The cause isolated from hemoculture depends on the place of the infection origin (out of hospital/in hospital); larger percentage of methicillin-resistant types was presented in in-hospital acquired infections chi2 11.352 df=1 p=0.001. And the chi-square test for independence showed both dependence of the preceding antibiotic treatment and the place of the infection origin in both categories of patients. Sepsis: chi2 = 22.92 df=1 p<0.0005; Bacteremia: chi2 = 9.89 df=1 p= 0.005. CONCLUSION: The results showed larger percentage of methicillin-resistant types in in-hospital acquired infections, as well as significantly larger percentage of hospital infections with the preceding antibiotic therapy, which puts in focus possible rationalization of including antibiotic therapy.

Clinical and epidemiological characteristics of novel AHIN1 flu.

INTRODUCTION: Swine influenza is respiratory infection caused by virus influenza A H1N1. OBJECTIVE: To show epidemiological and clinical characteristic of patients with confirmed influenza A H1N1 hospitalized at Clinic for Infectious Diseases of University Clinical Center Sarajevo. MATERIAL AND METHODS: We analyzed 127 medical records of patients with microbiologically confirmed pandemic influenza A/H1N1 (nasopharyngeal swab analyzed by PCR method). RESULTS: In our investigation female patients prevail (57%), age from 25 to 45 years old with medium difficult clinical picture (71.55%). Chi-square test showed significant dependence between sex and clinical status of patient (p < 0.05), dyspnea and clinical status of patient (p < 0.05), while statistical significance was nor proved related to comorbidity (p > 0.05), cough (p > 0.05), radiological confirmed pneumonia (p > 0.05), number of prehospital days of diseases (p > 0.05) and length of hospital care (p > 0.05). Significant impact on clinical status of patients is found related to age (p < 0.05), in a way that every year of age increase risk in 2.9% for more severe disease. CONCLUSION: Clinical and epidemiological parameters can impute severity of clinical status and therefore the outcome of disease.

Listeria meningoencephalitis in an immunocompetent person.

Listeria monocytogenes is a small, aerobic or facultative anaerobic, non-sporulating gram positive bacillus that can be isolated from soil, vegetation or animal reservoirs. There are six species of Listeria, and only L. monocytogenes is pathogenic for humans. Human disease occurs mainly in immunocompromised people, neonates and in pregnancy, while the cases in immunocompetent people are rare. CNS manifestations of the disease can be in form of meningitis, encephalitis, and also cerebritis and abscess since L. monocytogenes shows tropism for brain and brain stem as well for the meninges. In this case we presented 55 year old male patient with etiologically confirmed listerial meningoencephalitis, transferred from regional hospital tothe Clinic for Infectious Diseases with diagnosis of acute meningoencephalitis. Disease started 4 days before the admission. Prior to this the patient was completely healthy. In his history he denied any preexisting disease. At admittance he was febrile, with altered consciousness, disoriented, showing ocular deviation, dystaxia, and with completely positive meningeal signs. Neurologist diagnosis was rhombencephalitis. CSF analysis showed mildly opalescent liquor with pleocytosis 546/mm3 and polymorphonuclear cell predominance >70%. CSF culture showed positive isolate of L. monocytogenes. Initial therapy was: Penicillin G and Chloramphenicol, together with all other supportive and symptomatic therapy. After initial therapy and based on antibiogram, ampicillin was administered for4 weeks, followed by imipenemum for 10 days. Control CSF analysis showed pleocytosis and increased protein level and the patient was discharged as recovered with diagnosis of acute meningoencephalitis

[Evaluation of hepatitis C virus genotype and its influence on therapeutical respond on combined therapy with pegilated interferon A 2a (40)kD and ribavirin]. / Evaluacija genotipa hepatitis C virusa i njegov utjecaj na terapijski odgovor pegiliranim interferonom alpha 2a (40)kD u kombinaciji sa ribavirinom.

The aim of our study was to determine the genotypes of viral hepatitis C. We examined 54 patients with chronic hepatitis C who were treated at Gastroenterohepatology Department University of Sarajevo. We also monitored effects of therapeutical results in same group of patients. Polymerasa chain reaction (PCR) was used to quantified the number of HCV-RNA copies in 1 ml of blood. Genotype of virus was determined as well. We created therapeutical protocols based on genotype and quantity of virus that contained pegilated interferon alpha2a(40) kD and ribavirin. The result of our investigation presented that the highest number of patients, 25 had genotype 1a; 13 patients had genotype lb; 11 patients had genotype 3; 4 patients had genotype 4 and 1 patients with genotype 2a. At the end of therapy, 42 patients were HCV-RNA PCR negative; 7 female and 35 male. Four women with genotype 1a, responded on therapy; two with genotype 1b and one with genotype 3. Within the male group of patients (35 patients), 16 patients had a genotype 1a, 3 patients had a genotype 1b, 11 patients had a genotype 3, 4 patients had genotype 4 and one patient had genotype 2a. Patients who did not respond on therapy or were HCV-RNA-PCR positive at the end of therapy were genotype 1a and 1b. According to result of our investigation, genotype 1 is the most frequent among our patients, and the most severe damages in liver parenchyma are associated with genotype 1a and 1b. Genotype 1b also had less respond on therapy.

[Hospital sepsis and aggressive medical interventions]. / Bolnicka sepsa i agresivni medicinski zahvati.

AIM: To find out do the aggressive medical interventions have an effect on appearance of gram positive and gram negative hospital sepsis among 200 patients with positive clinical and laboratorial signs of sepsis and who have proved monomicrobial blood isolates. METHODS: Samples of septic patients were analyzed statistically by using x2 test and coefficient of contingency C. RESULTS: After we put gram negative so as gram positive sepsis to a correlation with the aggressive medical treatments, which proceeded, we got statistically significant results. CONCLUSIONS: Aggressive medical interventions impute hospital sepsis and etiology.

[Meningoencephalitis tuberculosis--primary isolation of resistant M. tuberculosis]. / Tuberkulozni meningoencefalitis--primarno rezistentni izolat M. tuberculosis.

Tuberculosis is one of the main causes of serious diseases in developing countries. Despite of decreasing tuberculosis in industrial countries, diseases is not eradicated. In last fifth years the picture of diseases is changed with large number atypical cases. Factor that is responsible for this are variable and includes primary infection in old ages, or problems that are in relation with immigration of populations. Tuberculosis meningitis disease witch appears mostly in childhood with high incidence in first three years of life. Most cases tuberculosis meningitis are caused with human types of tuberculosis bacillus, while bovines type is responsible for less than 5% of cases, but there are also reported cases of tuberculosis meningitis caused 3% atypical mycobacterium. In report is described a girl in age of two years sick of tuberculosis meningitis, she come from Kosovo, with positive epidemiological anamnesis. When she came to the hospital diseases had all clinical manifestation of serious meningoencefalitis. Very soon signs of decompensate hydrocephalus are developed. In the culture of cerebrospinalis fluid isolated Mycobacterium tuberculosis primary resistant on etambutol and rifampicin.

[Sepsis--clinical parameters of recognition and differentiation]. / Sepsa--klinicki parametri prepoznavanja i diferenciranja.

INTRODUCTION: Even today, early recognition of sepsis remains a great problem, requiring the search for clinical symptoms and signs with predictive features. AIM: to define the number of days of disease till hospitalization and value of some clinical signs in recognition and differentiation of patients with monomicrobial (M.A) gram positive and gram negative sepsis. PATIENTS AND METHODS: 200 patients with clear clinical and laboratory signs of sepsis, septic shock and monomicrobial aerobic bacterial isolate were included randomly. Patients are divided into two equal groups. RESULTS: patients with gram negative (m.a.) sepsis are hospitalized earlier relating to patients with gram positive sepsis (X2= 24,345; p< 0.001). Significance of differences in two basic groups of sepsis is the most evident for heart murmur (t=6,703; p<0,0001), shivers (t=3,313; p<0,001), afebrility (t=16,148; p<0,001), fatigue-exhaustion (t=4,472; p<0,001), pulmonary manifestations (t=3,497; p<0,001). CONCLUSIONS: results of investigation show the recognition of clinical symptoms and signs of sepsis, which enables the differentiation between gram positive and gram negative. Initially, this provides clinicians with a greater therapeutic reliability.

[Hospital sepsis and pre-existing disease]. / Bolnicka sepsa i preegzistentna bolest.

AIM: By retrospective study in a fifteen period from 1990 to 2004 to research if a pre-existential disease influences the appearance of gram-positive and gram-negative clear determinated hospital sepsis among 200 septic patients, selected by a random method and with clinic-laboratory signs of sepsis and monomicrobial blood culture. METHODOLOGY: Specimen of septic patients analysed in relation to the patient condition and statistically processed using chi2 test and contigential coefficient C. RESULTS: We received statistically significant results when we have correlated gram-negative hospital sepsis and pre-existential disease, until this significancy was absent in gram-positive hospital sepsis. CONCLUSION: Pre-existential disease can indicate sepsis, the place of acquisition and etiology.

[Analysis of amoxicillin-clavulanic acid (Xiclav) efficacy and the possibility of early switch from parenteral to oral therapy in the treatment of infections]. / Analiza efikasnosti djelovanja antimikrobika Amoksicilina + klavulanska kiselina (XICLAV) i mogucnosti ranog prelaska s parenteralne na oralnu terapiju u lijecenju infekcija.

Early transition from parenteral to oral antibiotic therapy switch therapy play a major role in treatment because of adverse reactions of long parenteral therapy. In the prospective, comparative and randomized clinical study the efficacy of two treatment regimens were analyzed: XICLAV (amoxicillin + clavulanic acid): parenteral regiment with early transition to oral therapy and parenteral regimen in patients with bacterial infections without transition to the oral dosage form, on the other hand. In our study we've analyzed 240 hospitalized patients in the Clinic of infectious Diseases in Tuzla and Sarajevo too, so in the Institution for infectious diseases in Zenica. The mean age of our patients was 39.6 years, 70.8% females. The major (50.5%) patients had urinary or respiratory tract infectious (bacterial pneumonia 38.8%) but several patients have had skin infections and sepsis. The first 120 patients were initially treated by Xiclav administered parenterally i.v. (adults at a dose of 3 x 1.2 gr i.v.; the children at a dose of 3 x 30 mg/kg) with early oral switch therapy (adults at a dose of 3 x 625 mg per os; the children at a dose of 3 x 25-50 mg/kg); whereas the others (120 patients) were treated parenterally by the regimen mentioned above. The mean length of i.v. therapy and hospitalization in the i.v. group was 4.12/10.21 days respectively (p > 0.05). The clinical efficacy switch of both therapeutic regimens was comparable. The resolution of all clinical symptoms and laboratory signs of infections was noted at 69% patients of both groups, with significant improvements at noted at 69% patients of both groups, with significant improvements at 21% patients and at 10% patients showed clinical failure. The tolerability of Xiclav was very good. The adverse reactions during treatment were observed at 5.2% patients. This study noticed satisfied clinical and bacterial efficacy so did tolerability of Xiclav in the treatment of bacteriological infections. Xiclav apply early transition from parenteral to oral therapy.